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Radiologic Images of Retrograde Ureterography Before and After Release of Bilateral Sacrospinous Ligament Fixation Sutures

Sylvester, Toni MD*†; Bond, Virginia MD*; Johnson, Harry W. Jr MD*†; Chai, Toby C. MD*†

Female Pelvic Medicine & Reconstructive Surgery: May/June 2012 - Volume 18 - Issue 3 - p 168–169
doi: 10.1097/SPV.0b013e318254f0b0
Case Report

Ureteral injury or compromise can occur after pelvic floor reconstruction for prolapse. Therefore, it is routine to perform intraoperative urethrocystoscopy at end of the operative case to confirm ureteral patency. We show retrograde ureterogram before and after release of fixation sutures from bilateral sacrospinous ligament fixation performed for stage III vaginal prolapse. The fluoroscopic images presented are intended to help pelvic surgeons visualize what could occur during sacrospinous ligament fixation. Furthermore, this case report illustrates how angulation of the distal ureter, without complete obstruction, may result in renal compromise.

Case report illustrates before and after retrograde ureterograms revealing distal ureteral obstruction with renal compromise and subsequent resolution after release of sacrospinous ligament fixation sutures.

From the *Division of Urogynecology and Pelvic Reconstruction, Department of Obstetrics, Gynecology and Reproductive Sciences, and †Division of Urology, Department of Surgery, School of Medicine, University of Maryland, Baltimore, MD

Reprints: Toby C. Chai, MD, Division of Urology, Department of Surgery, School of Medicine, University of Maryland, 29 S. Greene St, Suite 500, Baltimore, MD 21201. E-mail:

The authors declare that they have nothing to disclose.

© 2012 by Wolters Kluwer Health | Lippincott Williams & Wilkins